I was reviewing the CDM tutorial slides last night and came across slide #25 that describes 5 visit types: Inpatient, Outpatient, Emergency, Long term care, and Inpatient/Emergency. The documentation for the Visit_Occurrence table only specifies the first four visit types. When will the Inpatient/Emergency visit be used? Or should we be using it now?
I believe this is a new type or a proposed new type. We currently aren’t using it a Janssen because we are clear when something is Inpatient vs ER is most cases.
@rimma - weren’t you involved in the recommendation of this? Could you provide more detail?
There are several EHRs that have an Inpatient/Emergency encounter type (Epic does, or did-as they could have changed it), and sometimes it may not be efficient/possible/desired to separate these encounters into 2 distinct encounter types. So, it could be use under these circumstances. I don’t know if the documentation is lagging or if a future plan is not use this visit type.
We are on it. @rimma wants it too. The problem is that it is not backward compatible, because existing analytics will expect ER patient to have the ER type, and inpatient patients the inpatient type. The CDM is really bad with “Or” because you never know, and all queries for “both” are ambiguous. So, you and Rimma want it, I hate it, and now we have to figure out a good compromise. Or you just outvote. 
@Christian_Reich
I didn’t say “I wanted it” but I was explaining how/why it might be used. There also seems to be some confusion about whether it currently exists in the CDM or not per @MPhilofsky. I do have some recommendations for visit types and I was planning to discuss them with @rimma. And lastly for the record, neither have a said that “I don’t want it”.
So, what are you saying?
To prevent the “backwards compatibility issue”, we could include this change in the next version of CDM. Even if it’s just a mini-version update (like v5.0.1 to v5.0.2). I know that it is not ideal, but it would fix a lot of problems.
For the record, I support the “Inpatient/Emergency” visit type, since is applicable to all claims databases that store inpatient facility claims.
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This is a nice case where concept level standardization (content) is needed in addition to table level standardization (shell, syntax). (a set of visit-type “Athena concepts”)
I also see it with weight or height inside the MEASUREMENT table. See a proposal for addressing this here: http://www.ohdsi.org/web/wiki/doku.php?id=documentation:next_cdm:deeper_semantic
Will we change CDM shell version every time we clarify something within the underlying terminology?
Your concept-level standardization we want to call “Conventions”. We are working on the conventions for smoking. Currently, we have no way to create Conventions other than adding them to the CDM documentation.
But you are right, they deserve to be included into the CDM version. And in contrast to vocabulary changes, for which we cannot possibly make a change to the CDM version, this would make sense. The best way to handle it is the same as for structure changes: Let the community vote whether they go into hotfixes (point versions) or new main version.